Pennsylvania woman denied coverage for sepsis-related foot amputation

When a Pennsylvania woman required a partial foot amputation to stop a sepsis infection from spreading, she found the surgeon required an upfront payment — and the woman's "skimpy" health plan denied coverage for the procedure, according to The Inquirer.

Stephanie Sena's insurance plan, which she thought was a real health plan, actually was an accident and sickness hospital indemnity plan. The plan paid a set amount for specific services, and the amputation surgery was not on the list.

Under the ACA, health insurers can't discriminate against members based on preexisting conditions. However, skimpier health plans like short-term policies, while cheaper, don't have to comply with many of the ACA's consumer protection rules like covering preexisting conditions and basic health services. The plans have expanded under the Trump administration and brought with them familiar stories of patients being denied coverage.

Ms. Sena purchased her plan through a website called Health Insurance Innovations. She used an independent broker to purchase the short-term plan, and was under the impression she had more comprehensive coverage.

But the health plan paid nothing on her most recent hospitalization for sepsis. The emergency room visit charge was $15,508; an ambulance transfer, $3,533; and $3,512 for the amputation surgery.

Ms. Sena found a way to pay the upfront payment for the amputation procedure. Following The Inquirer's investigation, Ms. Sena received a $1,725 refund from the health plan for seven months of premiums. Still, she faces $19,000 in medical debt since enrolling in the plan, according to the report.

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